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Hearing rehabilitation in middle ear anomaly – case report
18 April 2018 (online)
A patient with microdelition syndrome 22q1, 29 years of age, with bilateral combined hearing loss received already a Vibrant Soundbridge (VORP 503) in the left ear. He can not wear his hearing aid on the right side any more due to multiple otitis episodes. During the operation on the left ear, many chain and facial nerve anomalies have been described and the VORP was positioned on the round window membrane. The right ear appears malformed to an even stronger degree.
Material and methods:
The BAHA soft band testing showed an improvement compared to the hearing aid in quiet but not in noise. A Vibrant Soundbridge implantation on the right side was advised against. We decided to implant a Bone Bridge here.
The rehabilitation with a Bone Bridge does not endanger the facial nerve. The implant is well accepted. Optical symmetry of appearance results from Samba sound processors on each side. The patient is usually wearing a cap, and thus the percutaneous implant with no transcutaneous abutment and implanted vibrating BC-FMT is the best solution. The ear canal is open and no further otitis episodes were reported. Audiometrically, better results than with the BAHA were observed, which can perhaps be explained by the better fixation with no attenuation through cutis, subcutis, muscle and optimal coupling to the bone.
The asymmetric care with Vibrant Soundbridge and Bone Bridge is possible when anomalies are present. In this case we could observe a better audiometric result in quiet with the Bone Bridge than with the hearing aid. The long-term results need to be followed for sound orientation assessment.